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Sperm-tracker and extraction system trialled on donated testes

Extracting sperm direct from testes may be about to get a lot easier. That's according to results of an experimental procedure carried out on testes from transsexual patients, donated post-removal.

The novel procedure, detailed in the journal BioPhotonics, involves something called probe-based confocal laser endomicroscopy (pCLE) and is designed to improve extraction success rates ahead of IVF. Laser lights were used to safely allow anyone extracting the sperm to see inside the tissue structures, image and film those views, then stain the sperm with fluorescent dye to ensure easy extraction.

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The studies -- carried out by Matthias Trottmann and his team from the Klinikum Großhadern, University of Munich -- are aimed at improving traditional extraction techniques, that have generally fared poorly. Testicular sperm extraction (TESE) is carried out pre-IVF when the male is unable to produce sperm when they ejaculate -- something that impacts around 10 percent of those men experiencing reproductive issues in Europe, according to the Munich team. The procedure involves a biopsy of the testis carried out under general anaesthetic, and in the case of microdissection TESE the same procedure is carried out under a microscope.

However, points out Trottmann and his team, "success rates of this technique are moderate, because the site of excision of testicular tissue is determined arbitrarily". Surgeons are taking a metaphorical stab in the dark when searching for the site of extraction, and a second round of biopsies is sometimes needed if enough sperm is not collected. The team continues by explaining how it sought a solution that would provide "non-invasive, real-time visualisation of tissue at histological resolution".

Testes donated from transsexual individuals that had opted for removal provided the ideal samples, since these patients had been taking medication ahead of the procedure to reduce sperm production. The sperm in their samples would therefore already be harder to track down.

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The team used light on the visible spectrum, since it was unlikely to cause any damage to the tissue being targeted. The fluorescent agent used to stain the tissue and sperm was also known to be safe, and the authors noted it did not appear to impact sperm motility.

During the experiments, the authors said they could "clearly visualise longitudinal and horizontal views" of the tubules, and confirm results recorded on camera and video by comparing them against results from another imaging technique, known as confocal laser scanning microscopy.

The team concludes: "When applying this technique, both the trauma of the patient and the risk of hypogonadism may be minimised because less tissue has to be removed during surgery." It's suggested the technique be used in conjunction with microdissection TESE in the future to improve results further. Nevertheless, the team is confident the procedure will pave the way for further study and even the deployment of a new standard one day.